I unabashedly admit that I have an anxiety disorder, two actually: generalized anxiety and post-traumatic stress disorder. While I’m not always a good student of self-care for anxiety, I do try my best each day to find little things to slow my mind’s engine from revving too high. If you’re among the anxiety disordered, you probably get it – the overthinking; the fretting over this and that; the what if, what if, what if; and the hyper-vigilance, if you have PTSD. The upside to all this is: You’re among good company.

Anxiety disorders affect 40 million adults in the United States each year. These disorders are the number one mental health issue among women, and the second among men. No worries if it so happens that you haven’t had the fortune of being DSM coded with one of these disorders; if you’re among the countless numbers of us who are unsure about the future of our nation, that’s enough to make you go bonkers. And with the holiday season fast approaching, ugh! Talk about an anxiety disordered person’s nightmare – crowed stores, traffic, “Jingle Bells” following you everywhere, pressure to spend just the right amount on a yankee swamp gift. Having an anxiety disorder is sometimes all consuming, mentally exhausting, predatory-like. There are days when I think of my anxiety disorders as the worst roommates I’ve ever had. If you get what I’m saying here, are you wondering how to kick your roommates (or roommate) out of your head and body for good? I wish I could say I had the one-size-fits all answer, but, alas, I do not. However, I do have a self-care for anxiety practice that might help during those most difficult, wonky-crazy moments when you can’t seem to get out of your own way.

After treating myself to a massage/reiki treatment a last month, the therapist asked if I had ever had any surgeries to my pelvic and abdominal area. I almost choked on my tongue. Yes, I had had surgeries: three abdominal and two pelvic. “I felt an outpouring, like hemorrhaging from those areas,” she said.  This could not be good, I thought,  but I had to ask anyway, because that’s what anxious people do, ask and ask again, just to be sure. “No,” she affirmed. “It is not good. You need that energy coming out of you for balance, to ground you.” Yikes, I thought. How much had I bled? What blood type matches imbalance negative? How many pints of blood do I need to bring my balance count back within the normal range?

Of course, she didn’t leave me bleeding all over the place. She looked at me with kind eyes and said I needed to give myself  some love and attention, a bit of self-care for anxiety. Because physical touch alone helps to reduce stress and anxiety, she encouraged me to place a hand over my pelvic/belly area each night while lying in bed. Then, with my eyes closed, tell myself that I am good. I am good enough. I am okay.

And so that’s what I’ve been doing. Sometimes I do forget, but I make up for it during my ten or fifteen minute periods of meditation. During those self-care for anxiety moments, I fill my head with not only good enough, I open myself up to all kinds of friendly  words: smile, joy, yellow, puppy, sunshine, laughter, starlight, full moon, beach, ocean, green, breath, bare feet, grass, warm bath, love, hugs, candle, art, cozy, blue, hope. Certain words often circle around again, which is just fine with me – there’s no such thing as too many smiles, full moons, hugs, or puppies, especially puppies.

I now leave you to fill your head with a lavender bath, soak for as long as you need to with your hand over the part of your body that is bleeding the most, and give yourself the transfusion you deserve: maybe it’s a  field of purple Calla Lilies or a walk in the woods, a warm cup of chamomile tea, or a love note to yourself.

Be well my dear friends.

Oh, one more thing: Don’t fret over the lumps in the gravy this Thanksgiving, because, as my mother likes to say, “It will only get worse.”

In the aftermath of the latest vehicle-ramming attack, this time in Toronto, I’ve been feeling a little more agitated and hyper-vigilant. Thank goodness, no one I know was injured or killed. Still, my brain can’t seem to fully let go of the horror. Most likely my reaction has a lot to do with post-traumatic stress disorder, a result of my own traumatic experience fifteen years ago, when an older driver confused the gas pedal for the brake and rocketed through the Santa Monica Farmers’ Market , striking dozens of pedestrians. Ten died; I was one of the survivors.  So, of course, each time I hear of yet another vehicle-ramming attack, my brain and body is yanked back fifteen years. And I can’t help but still feel the fear storm through all those who had been walking through Toronto’s north end when twenty-five-year-old Alek Minassian intentionally sped down a busy street in a rented van. I still taste the blood, hear the screams, hear the sounds of crushing glass and metal. For those who witnessed the attack – bystanders, rescue workers, family and friends of the victims – they too are likely suffering from PTSD symptoms. And imagine the grief stricken faces of the loved ones of the injured and dead when they received that unthinkable phone call, or saw the carnage unfolding on television.

For anyone who has survived, or witnessed (first hand or in the media) trauma of this kind – a car crash, terrorist attack, mass shooting – don’t be surprised if this latest tragedy has left you a little more overprotective of your children, fearful of crowds, or hype-aware of your surroundings each time you go for a walk. And maybe you’re experiencing a resurgence of nightmares. Though don’t be surprised if you’re experiencing hypo-arousal: numbed out and not present in the world around you. This kind of trauma rocks us at the core, gnaws into our sense of safety, cracks in half any sense of predictability.

For some, PTSD symptoms naturally resolve; for others it lingers. Studies have shown that up to five days after the 911 attacks, 44% of Americans noted at least one symptom of PTSD. Two to four months later, 11% of NYC residents reported persistent symptoms.

No matter how your PTSD symptoms present themselves, they are real, very real. So, please, talk to your family, your friends, your neighbors, to clergy, social workers, educators, to anyone who will listen.

Because

You

Deserve

To be heard

You

 Deserve

To be

Understood

This past Saturday, at least fifteen thousand people marched through downtown Montpelier, Vermont, in the name of women’s rights, human rights, compassion, unity, and equality. I was among the thousands who sloshed through mud puddles and climbed over snow banks, each one of us determined to stamp out hatred and bigotry.

I’m not one for crowds, especially large crowds; if you have an anxiety disorder, like PTSD, you know what I mean. But I packed my Xanax – just in case – and drove the 40 miles with my step-daughter (thank you Rachel for being there with me) from Burlington to Montpelier, waited in five-miles of backed up traffic on the interstate before making an illegal U-turn (I can’t tell you how good it felt to break the law!) so we could exit onto an alternate route leading into town, then parked a mile from the state house. From there, Rachel and I took our first steps toward the center of inclusivity: the golden-domed state house.

Montpelier may be the smallest capital in the nation, but our voices here in Vermont are far from small. Yesterday, as we marched together, thousands waved signs reading, “Yes we still can … We should all be feminists … We the people … complacency is complicity.” We sang and chanted and shouted against oppression and injustice. We spoke out loud for what is right: helping the homeless and the poor, treating with dignity women, people of color, Hispanics, Jews, Muslims, gays, LGBQTs, the young and the old. And the disabled.

I give the disabled a sentence of its own, not because I believe they’re superior to others; I do so because I know too many disabled people, mostly those who have sustained traumatic brain injuries (TBI) and are now living with chronic side-effects, such as vision difficulties, chronic anxiety, sleep disorders, and rip-roaring headaches. Due to their injuries, some find it difficult to engage in substantial gainful activity, a social security disability insurance (SSDI) term meaning your medical condition prevents you from doing more than “insignificant” work. And if your disability prevents you from working twenty hours or more a week, the typical threshold for receiving employer-based benefits, this likely outcome is this: no health insurance. With the enactment of the Affordable Care Act, though, those with disabilities had options, and they didn’t have to worry about being discriminated against for having a pre-existing condition (a TBI for instance). The ACA offered increased accessibility to community health centers, and enacted a provision that axed annual and life time limits – a godsend for people with disabilities. For those who receive SSDI and Medicare under the program’s guidelines, they are (or should I say “were?”) protected.

But it’s 2017, and winter has arrived. “He who must not be named” plans to eviscerate the ACA, with no alternative other than the ambiguous executive order he signed just hour after he was inaugurated directing federal agencies to relieve individuals, state governments, businesses, and health insurance companies from “burdens” placed on them by the ACA.

Whatever that means? In the meantime, there are nearly 50 million people in the U.S. who have a disability, and about 8.8 million who receive SSDI benefits. Though “he who must not be named” promises Medicare for All, this is sheer talk from a man who, well, likes to talk. And, of course, “he” has to deal with the Republican controlled congress. What do the millions receiving Medicare under SSDI benefits – and those sixty-five and older – have to look forward to?

I wish I had a magic wand to make it all better, but I don’t. Yet, I do have my voice. I share my voice with you, sing and chant and cheer for you, keeping in mind the words that Martin Luther King Jr. spoke in 1965: “Our lives begin to end the day we become silent about the things that matter.”

The more we speak, the louder we speak, “about the things that matter,” the closer we come together, marching forward toward human progress and shaping a world in which every single one of us matters.

Are you resilient? Do you sink or swim when faced with obstacles or stressful events? Say you grew up poor, I mean really poor, and all you had to eat for lunch each day at school were saltine cracker and butter sandwiches. Because you didn’t want your more well to do schoolmates to feel sorry for you, each time you crunched down on your cracker sandwich and licked the butter from the salted edges, you smiled. Despite your chronic adverse circumstances – low socioeconomic status – you worked hard in school. In fact you excelled, and you continue to do so: maybe at work or as a parent, or both. That’s resilience.

If you’ve never experienced a life challenge (unless you have lived in bubble wrap for all of your existence, I find this nearly impossible), you’ll never know whether or not you’re resilient. Adverse events can be chronic, as in the scenario I depicted above, or acute, as in witnessing a trauma or being a victim of an accident.

To better understand what makes us resilient, one researcher has looked at what are called “protective factors,” the particulars of individuals’ backgrounds, including personality, that play a role in their success, regardless of challenges. In follow-up to his research, his students identified factors that fell into two different groups: psychological makeup, disposition, or environmental influences in one group, and pure chance in the other. Another, larger study attempted to decipher the factors contributing to resiliency. Though, similar to the former study, luck played a role in some cases, psychological constitution was instrumental in the majority of situations. They might not have been geniuses, but the more resilient children possessed a healthy sense of self. They were willing to seek out new experiences, take chances, utilize the skills they had to be successful. One researcher describes these children as having an “internal locus of control,” meaning that they believed they, rather than outside circumstances, had control over their outcomes. They believed they were the authors of their life scripts.

As with most things though, resilience fluctuates. We’re human after all: if we’re burdened with one stressor after another – divorce, death, a job loss, injury – we tire and lose resilience (think of an overstretched rubber band). But the good news is: we just might be able to learn how to be resilient. Another researcher has discovered that individuals who did not bounce back so easily as children were able to develop resilient skills later in life, enabling them to prosper.

If we have the capacity to create our outcomes, then why not say resilience is an offshoot of perception, another human element within our control. As a clinical psychologist at Columbia University says, “Events are not traumatic until we experience them as traumatic.” Because we’re the ones who label the event as traumatic, we also have the capacity to re-label it as something else – simply as an experience, for instance. In this way we become more resilient. Of course, it’s not always that easy. Because we’re human, we agonize over this and that, lose sleep over this and that. It takes re-training the brain, taming our unwieldy thought patterns, tying our worries and fears into a constrictor knot. Though this hackneyed phrase may cause you to roll your eyes (Yeah, yeah, I’ve heard this, how many times now?), I’m going to share it with you anyway: If we expect something to become true, it will become true. If we focus on an adverse event as potentially harmful, we sink. If we focus on that same event as a challenge, we swim – and win.

What did you eat for breakfast this morning? I had yogurt with blueberries, lots of blueberries. Akin to gulping down a mug of coffee, these plump babes are part of my morning routine. The sweet burst on my tongue makes me smile and, let’s admit, smiles are more attractive than frowns. If I miss a day munching on an overflowing cup of blueberries, my mojo is all messed up. Thank goodness for blueberries. Why? Not only are they packed with anti-inflammatory, heart-protective, brain-healing extracts (see earlier blog post), they are the anti-depressant of the future.

Based on animal studies, researchers at Louisiana State University’s School of Veterinary Medicine suggest that blueberries may help those suffering from post-traumatic stress disorder. With the rise in PTSD diagnoses, this is good news, particularly since suicide is a very real risk among sufferers.

When researchers induced PTSD-like symptoms in rats, they found that, in comparison to “normal” rats, they had unusually low levels of SKA2, a gene expressed at unusually low levels in people who have committed suicide. The PTSD rates were fed a blueberry-rich diet – as much as two cups – and the results showed increased levels of SKA2 compared to the non-PTSD rats fed a regular diet. The SKA2 study came in follow-up to an earlier one in which blueberry-fed rats showed increased levels of serotonin, the saving grace brain chemical that makes us happy. Researchers plan to further evaluate the link between blueberries and SKA2, with the hope of finding a single pathway by which blueberries can relive both depression and suicidal behaviors.

In the meantime, since blueberries are harmless (unless they are sprayed with chemicals even a veteran linguist can’t pronounce), why not feed your brain a cup or two? And blueberries just might be better than taking drugs: anti-depressants, particularly Serotonin Re-uptake Inhibitors (SSRIs), used to treat PTSD are not always successful. Paradoxically enough, they have been linked to increased suicide tendencies in some people.

Hmm … if two cups of blueberries a day equals, say, twenty milligrams of an SSRI a day, and there are three hundred sixty-five days in a year, if my math is correct, that comes to seven thousand three hundred milligrams of said SSRI versus seven hundred thirty cups of blueberries. Pass the blueberries please.

You’ve heard of “burnout,” right? Your work environment is making you miserable, so miserable that you feel unfulfilled, depleted of energy, stripped of all motivation to effect change in the workplace. If you’re a healthcare professional, undoubtedly, you know all too well about burnout. But then there’s “compassion fatigue.” While individuals working in any kind of job setting can experience burnout, compassion fatigue is unique to those exposed to trauma while working in a helping profession: nurses, firefighters, police. Because you’re in the helping profession, you feel the onus is on you to save peoples’ lives, to make them better, to alleviate their pain, so you sign up for extra shifts, and, if you’re a nurse, offer to take care of the sickest patients. But what happens when your patients have little, or no family support, or are constantly ringing the call bell, making demands (get me water, I need more pain meds, I need something to help me sleep)? You feel like Sisyphus – no matter how many times you push the boulder up the hill, it keeps rolling back down into your weakened arms. You’re worn down, irritable, angry. That’s compassion fatigue, when you can no longer muster the sympathy to care for your patients because you’ve been exposed to the same kinds of patients again and again, and have answered an uncountable number of call-bell dings, but the bells keep dinging, and you want to keep helping, but, at the same time, you want to run.

It’s worth noting, however, that compassion fatigue doesn’t necessarily mean individuals experiencing it lack compassion, not at all. They still care about their patients. Instead, as a nursing professor at the College of Nursing at University of Arizona says, compassion fatigue is more like feeling too “full,” and even suggests a different name for it: “emotional saturation.”

Not only are healthcare professionals at risk for compassion fatigue, though, family members caring for loved ones with, say, a traumatic brain injury or dementia, are at risk too. Even those who hear about another’s traumatic experience over and over again are affected. I bring these scenarios into the mix because, sadly enough, I suffered from compassion fatigue when I worked tirelessly to navigate my father’s emotional swings, and, as he slipped into Alzheimer’s, made sure he was safe at home because he had insisted he never be put in a nursing home. And I’m witnessing compassion fatigue again, as my husband and his siblings stumble then pick themselves each day, determined to keep their aging mother safe from the ravages of dementia.

But it is possible to care too much, so much that it hurts. When I say hurt, I mean really hurt, as in traumatized hurt. Being pre-occupied with others’ suffering can cause “secondary traumatic stress” for the helping individual. It’s not unusual to experiences symptoms of post-traumatic stress disorder: anxiety, hyper-vigilance, irritability, impatience, withdrawal, poor concentration, sleep disturbance, nightmares, the list goes on.

What’s the cure for compassion fatigue? Boundaries and self-care. In other words, set limits, say no even when you want to say yes, remind yourself to take time out, meditate, go for a walk, keep a journal, draw, listen to your favorite music, dance, do yoga, take a bath, read a novel, watch a funny movie. Watch the sun set. Watch the sun rise.

For more resources on how to evaluate whether or not you have compassion fatigue and how to prevent/treat it, go to compassion fatigue and healthy caregiving.